Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
PP
Alexander Stevens PA Programme Leader 2018
MSc Physician Associate
Studies
A Quick Reference Guide to Hosting PA Students in GP
1
What is a Physician Associate?
“A collaborative healthcare professional with a generalist medical education, who
works alongside doctors, providing medical care as an integral part of the
multidisciplinary team. Physician Associates are dependent practitioners working
under medical supervision, but who are able to work autonomously with
appropriate support”
Physician Associates will support doctors in the diagnosis and management of patients in
primary and secondary care.
UK Physician Associate Training Physician Associate programmes consist of a mixture of University-based teaching and clinical placements.
To practice as a Physician Associate, students must also pass the Physician Associate National Examination and recertify every six years thereafter.
A Quick Reference Guide to Hosting PA Students in GP
2
The PA MSc Training Programme at UWE
90 weeks over two years
EWBL = Evidencing Work-Based learning (research project)
Core module themes:
A Quick Reference Guide to Hosting PA Students in GP
3
Primary Care Placements
Overall aims: The aim of primary care PA student placements is to give exposure to the
breadth and depth of general practice along with professional role modelling, exposure to
patients and consulting, and supervised practice. We will be undertaking the majority of
clinical skills/clinical medicine teaching and summative assessment of competency and
knowledge at the university – but we would certainly be responsive to your feedback about
the student during their time with you.
Tariff: Each practice will receive £97.35 per PA student per day for primary care placements
Academic Year 2018-19 – first year Academic Year 2019-20 – second
year
Year one: The aim of year one placements is
to immerse the student into primary care and
allow them to develop their patient
consultation skills – focusing on initiating the
session, information gathering and core
systematic physical examination skills.
The first (one-week) block will be
observational experience with both GPs and
the range of other primary care team
members.
The second (four-week) block will be
observational for the first one to two weeks progressing onto observed practice/ joint
consulting.
The third and fourth blocks (both three-weeks) will comprise joint consultations (sitting in
with GPs and other practice members) progressing onto solo consultations with
discussion/review by the GP or other experienced practice members.
The rate at which each individual student progresses is dependent upon your judgment of
their learning and capabilities.
Year two: The year two block (three-weeks) should aim to support the student in
performing the whole patient consultation, including management, explanation and
planning. The PA student should be encouraged to see patients and practice consultations
both in joint clinics and solo consultations (with GP review).
By the end of year two, PA students should be expected to conduct consultations at a
similar level to a year four/five medical student – albeit with a focus on general clinical
medicine.
Block Dates
1 29th October – 2nd November 2018
2 4th March – 29th March 2019 or 6th May – 31st May 2019
3 10th June – 28th June 2019
4 8th July – 26th July 2019
Block Dates
1 4th May – 22nd May 2020
A Quick Reference Guide to Hosting PA Students in GP
4
How Does our PA Curriculum Integrate with Placement Blocks?
Students spend 27 weeks in Y1 and 14 weeks in Y2 at university covering the following:
Weekly
University
Structure
Curriculum covered by the start of each GP placement block:
GP Block
Weekly Clinical Medicine topic
Communication Skills
Clinical Examinations
Procedural Skills
1 Lower back pain, HTN, Asthma, Dyspepsia, Diabetes, Headache, Iron deficiency anaemia (TATT), Vertigo, Sore throat
Introduction to communicating with patients, consultation models, communication micro-skills, initiating the session, information gathering, sharing information and breaking bad news
GALS Peripheral vascular system Respiratory system Gastrointestinal system Nervous system
Handwashing Manual BP Observations Venepuncture
2 Renal colic, Chest pain, COPD, Colon cancer, Thyroid disease, Movement disorders (PD), Ophthalmology (red eyes), Heart failure, Haemoptysis, Upper GI bleed, Osteoporosis, Stroke, Knee pain, Dermatology
Symptom specific information gathering and information sharing
Digital rectal Thyroid Neck Cerebellar Eye A-E approach Knee Hand & Wrist Hip Skin
IV cannulation Urinalysis ECG recording PEFR Interpreting spirometry Inhaler technique Injections Suturing NG tube insertion
General Hospital Medicine Placement (four-weeks)
3 Sepsis (UTI), Prostate disease
Symptom specific information gathering and information sharing
Testicular Hernia
IV fluids Catheterisation
4 Oncology Symptom specific information gathering and information sharing
Breast
Y2 GP block
Y2 University Learning and Placements in O&G, Paeds, Mental health, General Surgery, Front Door Medicine (ED, AMU, SAU)
MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
Clinical Science Pharmacology & Therapeutics
Lunch Lunch
Lunch Applied Clinical Medicine
PBL Reveal 2
Break Break
Clinical Skills End of PBL Seminar
New Topic Intro
SDL End of term
simulations/formative
OSCEs/Research Methods
New Topic Presentations (10 mins+10
mins Qs x3)
Lunch
PBL Reveal 1
The PA as a Professional
E-anatomy & SDL
Topic Quiz
Communication Skills
A Quick Reference Guide to Hosting PA Students in GP
5
Programme Assessments
At the university, students undertake yearly summative SBA MCQs exams, OSCEs, patient-
case presentations and professionalism assessments.
Clinical Portfolio: On placement, students are required to maintain a yearly portfolio of
evidence. This forms a pass/fail assessment marked by the programme team and contains a
record of formative learning experiences, student reflections, and end of year summative
assessments.
GP Placement Assessments: GP supervisors should complete a start of placement
learning agreement with the student at the beginning of each placement year. A summative
end of placement review should then be completed at the end of each placement year (this
contains a professional behaviours assessment, review of competencies, and a confirmation
of the clinical hours). Other formative assessments are outlined below:
Assessment type
Task to be completed
Minimum no to be completed
Assessment to be completed by
Time required
Formative Start of placement learning agreement
One per year
GP supervisor 20 minutes
Formative Mini-Clinical Evaluation Exercise (Mini-CEX)
One in Y1
Two in Y2
GP*, Advanced Nurse Practitioner*, Paramedic Practitioner*
15 minutes
Formative Case-Based Discussion (CbD)
One in Y1
Two in Y2
GP*, Advanced Nurse Practitioner*, Paramedic Practitioner*
15 minutes
N/A Direct Observation of Procedural Skill (DOPS)
N/A Any clinician competent in the observed skill
Dependant on the skill
Formative Multi-Source Feedback (MSF)
Three per year
Any member of the practice team
10 minutes
Summative End of Placement Review
One per year
GP supervisor 20 minutes
*assessors must be experienced and familiar with assessment and feedback methodology
Mini-CEX: A mini-CEX provides a snapshot to the student on how they are performing in a
given area (i.e. history, examination, clinical reasoning or communication).
CbD: The CbD is a structured discussion around a given patient case. It’s aimed at giving
insight to the supervisor about the level of knowledge possessed by the student and
feedback to the student about further areas of clinical learning and development.
A Quick Reference Guide to Hosting PA Students in GP
6
Supervising Arrangements for Physician Associate Students
We would need the student to have a named clinical supervisor who takes overall
accountability for the student’s placement experience. They should meet with the student at
the start of their placement and then review them at a mid and end-point of each year
The student would also need an individual to sign their placement hours each week (this
needs to be a clinician or practice manager who sees them daily).
It is important that every patient seen by a student is reviewed by a suitably experienced
clinician. The exact level and evolution of this supervisory relationship should be guided by
the development of the student as they progress through their placement with you. Albeit,
they shouldn’t be seeing patients on their own without review.
The definition of a PA is that they work under the supervision of a physician. However, in
practice, a PA graduate with experience doesn't always need the physical presence of a
supervisor for every patient seen by the PA. Dependant on the professional relationship and
the clinical acumen demonstrated by the PA, the supervisor can act as a contact and support
mechanism – akin to the GP consultant model.
Example in practice Physician Associate Student on four-week placement in GP Practice. On a day to day basis they
shadow and undertake clinical duties working closely with the GP and Practice Nurse, as well
as with other members of the health care team, who can sign off their competencies, as well
as working with the multi-disciplinary team. Their timetable was developed by the Practice
Management Assistant working with practice colleagues; however, overall accountability was
with the named supervising GP.
Dissertation project
PA students will be undertaking a maters project and we are keen for them to align this with
primary care. The students would benefit from having early, and then continued
involvement in practice audits, clinical governance projects and other activities so that they
can base their dissertation on an area that is helpful for the practice. We also hope that the
practice can gain some benefit from having the student involved in these activities.
HEE incentive for graduate PA recruitment into primary care
HEE have announced another pocket of funding for those practices that demonstrate a
preceptorship programme of PA graduate recruitment into primary care. Please contact the
PA programme team to learn more: [email protected]
A Quick Reference Guide to Hosting PA Students in GP
7
Closing statement
All in all, we would like the process of taking a PA student to be akin to a practice
developing a medical apprentice. You can essentially mould and develop a future PA to suit
your needs and medical workforce demands.
This can ideally be viewed as a two-year investment in the future, and this is the reason we
are asking a practice to host the same student(s) for their entire placement.
The overall purpose of PA student placements is for the student to gain real life experience
and exposure to the fascinating and diverse world of primary care.
The main focus of a
PA upon graduation
is to ensure they
are competent in
assessing patients,
recognising and
managing common
conditions and
identifying and
referring red flags
or complex
conditions.
We thank you for hosting these placements and hope this is a mutually beneficial experience
that empowers you to recruit PAs in your wider workforce of the future.
Alex Stevens
Alexander Stevens PA-R, MSc, PGDip, PGCert (Clin Ed), BSc (Hons), FHEA
Programme Leader MSc Physician Associate Studies
UK Physician Associate Schools Council Secretary
Room 023, 2BBC,
Department of Allied Health Professions,
University of the West of England,
Glenside Campus
Bristol BS16 1DD 0117 3287743
Email: [email protected]
A Quick Reference Guide to Hosting PA Students in GP
8
Appendix
A Quick Reference Guide to Hosting PA Students in GP
9
Primary Care Learning Objectives
KNOWLEDGE By the end of their training a PA would need to know about?
Diagnosis and management of chronic conditions in the community (e.g. Diabetes, COPD, asthma, heart failure, ischaemic heart disease, hypertension, leg ulcers)
Recognition and management, especially natural resolution of, minor illness in adults and children
Diagnosis and initial management of acute and chronic skin conditions in adults and children
Community antenatal care Community recognition and initial management of common mental health disorders
(e.g. depression, anxiety, grief, bereavement and dementia) Recognition and initial management of common gynaecological and women’s health
problems Diagnosis and initial management of common ENT and ophthalmic conditions Recognition and initial management of acute respiratory disease in children and
adults, including the indications for use of antibiotics and recognition of conservative management
Diagnosis and initial management of common GI conditions (e.g. Irritable bowel syndrome, constipation, gastroenteritis, dyspepsia
Knowledge and application of “red flag” and 2 week wait criteria for possible cancer diagnosis referral
SKILLS By the end of their training a PA would need skills in?
Bio-psycho-social assessment Eliciting of Ideas, Concerns and Expectations (ICE) Core systematic clinical examinations appropriate for primary care To be able to take mental health history appropriate to Primary Care
Assessment of suicide risk and assessment of severity of depression Recognise opportunities for and perform opportunistic health promotion (e.g. blood
pressure and weight measurement, smoking, alcohol, exercise, immunisation and screening advice
Understand and be able to implement an appropriate safety netting plan Take a venous blood sample using appropriate technique Undertake respiratory function tests including peak flow measurement Instruct patients on the use of inhaled medication devices Take nose, throat and skin swabs
Perform an ENT examination Obtain a cervical smear and cultures for HVS
ATTITUDES By the end of their training a PA would need to have attitudinal, higher and organisational learning in?
Awareness of how a ‘Physician-PA’ team can work in practice and how PAs can function in multi-professional teams used in the community
A Quick Reference Guide to Hosting PA Students in GP
10
Awareness of the PAs professional and clinical competence boundaries and effective team working under supervision
Understand and recognise how workload, time management and organisation influences performance and patient care
Understand and recognise strengths and learning challenges with personal work load and time management issues
Common Patient Presentations
PA students should be familiar with the following patient presentations upon graduation
and should be able to manage/diagnose/refer appropriately as stipulated in the
Competence and Curriculum Framework for PAs:
Addiction Altered sensation (including loss of feeling in lower
limbs) Anxiety: abnormal
Appetite/weight: alteration
Back pain Blood loss
Breast problems (lump, pain, discharge, surface changes)
Children: Failure to thrive
Children: Developmental problems Children: Short stature
Children: Unexplained injury Circulatory abnormalities of the limbs
Collapse/reduced level of consciousness (including fits)
Cough
Cutaneous/subcutaneous swellings Disordered mood
Disordered thinking Distension: abdominal
ENT problems
ENT Emergencies Eye problems
Eye Emergencies Falls/faints (syncope)/dizzy turns
Fertility / Infertility
Fever GI disturbances including vomiting/altered bowel
habit Head and neck lumps
Headache Hypothermia
Injury: Head & Neck
Injury: Extremities
Injury: Abdominal & Pelvic Injury: Thoracic
Joint pain/swelling Mass: abdominal
Memory loss
Menstrual changes / problems Micturition abnormalities (including frequency,
volume, colour and incontinence) Movement: loss of/abnormal (inc. inability to
walk, shaking hands)
Oedema Pain: abdominal
Pain: chest (including heartburn) Pregnancy: problems in
Prolapse Sciatic leg pain
Scrotal and groin swellings / pain
Sexual dysfunction Sexually transmitted infection: concerns about
Shortness of breath Skin changes: colour, ulceration, pruritis, rashes
Sleep disorder
Speech disturbances Swallowing difficulties (dysphagia)
Tiredness Visual disturbances
Voice changes
Weakness (both focal and general)
A Quick Reference Guide to Hosting PA Students in GP
11
Who should they spend time with on placement?
The make-up of primary care teams can vary widely. Part of the time on placements should be devoted to meeting the members of the team, understanding their roles and how they communicate with each other to meet the needs of their patients, after all, qualified Physician Associates and Physician Associate Students work as part of the multi-disciplinary team.
Members of the team can also get involved in some of the assessments that the students
need to complete on placement, such as DOPS assessments or multisource feedback.
Practice Team Community teams Community services
GPs Midwives Pharmacists
GP receptionists Health visitors Dentists
Administrators Counsellors Opticians
Practice Manager Visiting community teams
eg. drug and alcohol team,
mental health team
Support groups eg. Relate,
Age Concern
Nurses and Health care
assistants
District nurses, advanced
practitioners and community
matrons
.
Nurse practitioners Young person clinics
Family planning
GP with special interest
clinics
PAs in General Practice Physician Associates are trained as ‘generalists’ and have the potential to undertake a wide range of roles under the supervision of a GP including:
Telephone triage Open surgery, managing their own lists
Chronic disease management Ordering investigations Home visits Liaison and referrals with other teams and services Procedures such as coil fittings, contraceptive implants 6/52 mother and baby checks Minor surgery Complete reports: holiday cancellation forms, DWP forms and insurance medicals Assist GP (for example, HGV exams, DVLA forms etc which are then signed by the GP)
A Quick Reference Guide to Hosting PA Students in GP
12
A Quick Reference Guide to Hosting PA Students in GP
13
A Quick Reference Guide to Hosting PA Students in GP
14